SARS-Coronaviruses and Highly Pathogenic Influenza Viruses
Section 3: Responding to exposure events
As described in Sections 1.1.3 and 1.1.4, all events will be documented in an Event Log and reported to the Supervisor/Principal Investigator. These events must be immediately investigated to determine root causes. Periodic reviews also should be performed to assess for trends. Prevention efforts, such as addressing knowledge deficits or workload issues that may have contributed to the breach, must be undertaken, and any changes in protocol must be evaluated for efficacy.
An initial risk assessment will be performed for each exposure event based on the assessed procedural risk and the nature of the breach, i.e. exposure potential. Initial determination of exposure risk after reporting of an exposure event will be performed in-house by the Supervisor/Principal Investigator and the Wadsworth Center Biosafety Officer, and if determined appropriate, the Risk Assessment Group will be activated via the Wadsworth Center senior administration (see Section 2.1.3). The Risk Assessment Group will consist of:
- An infectious disease medical provider
- A Department of Health epidemiologist
- Two Wadsworth Center personnel i.e., the individual's immediate supervisor plus another scientist with relevant pathogen or BSL-3 laboratory experience
- The Wadsworth Center Biosafety Officer
If the risk is determined to be low, moderate or high, the NYSDOH Bureau of Communicable Disease Control will be contacted. Criteria used for risk assessment are described in Section 7.
3.1: If the initial in-house risk assessment of the exposure event by the Supervisor/Principal Investigator and the Biosafety Officer identifies no risk of exposure:
3.1.1 The employee may continue to work and no further action is necessary. The Risk Assessment Group need not be convened.
3.1.2 The employee should be reminded to report any fever or symptoms of respiratory infection to the Supervisor/Principal Investigator as per the standard protocol.
3.2: If the initial in-house risk assessment of the exposure event by the Supervisor/Principal Investigator and the Biosafety Officer identifies a low risk of exposure:
3.2.1 A Wadsworth Center Incident Report will be filed by the employee.
3.2.2 The Local Health Department and NYSDOH Bureau of Communicable Disease Control will be notified.
3.2.3 The Risk Assessment Group will be notified that a potential exposure event has occurred (see Section 2.1.3).
3.2.4 The completion of the Daily Monitoring Log of Laboratory Personnel (Attachment 1) will be implemented. The Log will be monitored daily by the facility-designated person in conjunction with the Wadsworth Center Biosafety Officer and in frequent consultation with the consulting Infectious Disease Medical Provider. For ten days following the event, the individual will report to the Laboratory Chief or Division Director to record presence/absence of the following symptoms: fever ≥100.4°F, lower respiratory symptoms (cough, shortness-of-breath), sore throat, rhinorrhea, chills, rigors, myalgia, and/or headache. Additionally, diarrheal illness may be present with SARS and influenza. On work-days the employee will contact the Laboratory Chief or Division Director before reporting to work. On weekends or holidays the Laboratory Chief or Division Director will be called at home.
3.2.5 If any of the above symptoms develop within the ten day period, laboratory personnel should follow the illness protocol in Section 4, Scenario 2 below.
3.3: If the initial in-house risk assessment of the exposure event by the Supervisor/Principal Investigator and the Biosafety Officer identifies a moderate to high risk of exposure:
3.3.1 A Wadsworth Center Incident Report will be filed by the employee.
3.3.2 The Local Health Department and NYSDOH Regional Epidemiology Central Office will be notified.
3.3.3 The Risk Assessment Group will be notified that an exposure event has occurred (see Section 2.1.3) and completion of the Daily Monitoring Log of Laboratory Personnel (Attachment 1) will be implemented.
3.3.4 The laboratory worker will be placed on leave for 10 days post-event and will maintain home isolation. Surgical masks and a thermometer will be supplied by the Wadsworth Center. The Local Health Department will be consulted on home isolation procedures.
3.3.5 The log will be monitored daily by the facility-designated person in consultation with the Infectious Disease Medical Provider if symptoms develop.
3.3.6 If any symptoms develop follow Section 4, Scenario 3.